Learn about different types of medications that are now available to treat the symptoms of Crohn's disease

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Crohn’s disease is an inflammatory bowel disease (IBD) that affects the digestive system. Because Crohn’s disease can attack any part of the digestive track, and because each person responds to Crohn’s disease medication somewhat differently, treatment plans are highly individualized.

Miguel Regueiro, MD, of the University of Pittsburgh Medical Center says that Crohn’s “treatment depends on the ‘phenotype’ — where the disease occurs in the body. There are several classes of medications, and there are pros and cons to each.”

Here are the main medication classes used to treat inflammatory bowel diseases, such as Crohn’s disease:

Aminosalicylates

Crohn’s disease is an inflammatory bowel disease, which means that part of the bowel is inflamed. “Aminosalicylates are anti-inflammatories,” Dr. Regueiro says. “Aminosalicylates are very safe, but a downside is that the patient usually needs to take a lot of pills.”

Aminosalicylates are a good option for people with mild forms of Crohn’s disease. However, “this type of anti-inflammatory doesn’t work [as well as other medication options] for most Crohn’s patients,” he warns. Aminosalicylates can be taken orally or delivered via a suppository or an enema, and some patients find that a combination of all three works best.

Antibiotics

“Some antibiotics have had success fighting infection in people with Crohn’s,” Regueiro says. Metronidazole (Flagyl) and ciprofloxacin (Cipro) are two antibiotics that are most often prescribed for people with IBD.

There are side effects associated with these antibiotics, though. Metronidazole can cause nausea, vomiting, and diarrhea, as well as headaches or dizziness. A serious side effect that should not be ignored is tingling in the hands and feet. Ciprofloxacin is considered the safer of the two; rare side effects of cipro include nausea, vomiting, restlessness, and abdominal pain.

Corticosteroids

“Corticosteroids, a class of steroid hormones, are extremely effective at reducing inflammation; their downside is their side effects,” Regueiro says. Corticosteroids can lead to high blood pressure, bone thinning, weight gain, insomnia, and emotional swings, among others. Corticosteroids can be taken orally, through an IV, or via an enema.

“Budesonide (Entocort) is a new type of corticosteroid that may not have as many side effects,” Regueiro says. It targets the intestine, and the rest of the body does not absorb as much of the drug, which leads to fewer side effects.

Taking corticosteroids less often and at a lower dose can also limit side effects. Doctors may prescribe corticosteroids to bring acute attacks of Crohn’s disease into remission, then have patients switch to safer, gentler drugs for long-term maintenance.

Immunomodulators

“Immunomodulators suppress and target the immune system directly,” says Regueiro. Although we do not know exactly what causes Crohn’s disease, evidence suggests that an overactive immune system plays a part. Immunomodulators work by weakening the body’s immune system, which in turn reduces the inflammation that characterizes Crohn’s disease.

Immunomodulators are usually taken orally or by injection; in cases where Crohn’s disease affects the mouth or the perineum (the area around the anus), immunomodulators are applied directly to skin. Because immunomodulators work by suppressing the immune system, people taking them are at greater risk for developing infections.

Biologic therapies

This is the newest class of Crohn’s disease medications, says Regueiro. Biologic therapies, also known as biologic response modifiers, “contain anti-TNF agents and are very effective. They do have some very serious, but extremely rare side effects, though,” he says.

TNF stands for “tumor necrosis factor,” which is a type of protein that controls inflammation in the body. By targeting only this protein, instead of your entire immune system, your body can still fight off germs and viruses that come your way. Adalimumab (marketed as Humira), certolizumab pegol (Cimzia), infliximab (Remicade), and natalizumab (Tysabri) are all biologic therapies that have been approved to treat people with Crohn’s disease.

Talk to your doctor about whether a new treatment, such as biologic therapy, is an option for you. As better, more targeted drugs become available, there will be more possible combinations to help you get your Crohn’s disease symptoms under control.

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